The purpose of the proposed program is to bring additional basic immunochemical, biochemical, and cell biology techniques to bear on the clinical problems of rheumatic disease and to continue existing clinical and pathophysiologic investigative programs. Studies on the chemical mediators of tissue injury continue to focus on the development of immunochemical methods for the measurement of the kinin system, the fibrinolytic sequence, and certain aspects of the clotting system, and the application of this methodology to determining the roles of these systems in rheumatic inflammation. Other studies include the measurement of the individual components of the classical and alternate complement sequences in serum and synovial fluid in an attempt to determine the mechanism for the intra-articular activation of this sequence in the rheumatoid joint. Effector molecules released from one cell, such as the mast cell, polymorphonuclear leukocyte, and lymphocyte, and acting to alter the function of other cells are being analyzed with the concomitant development of clinical assays. An in vitro method has been applied to the study of cellular immunity in man and is being used to assess the possible contribution of this reaction mechanism to various disease states. Investigations of the serologic abnormalities have revealed the presence of antibody to double stranded RNA, and this lead is being actively pursued. Other programs being continued include: further investigation of the relationship of gouty arthritis to coronary artery disease; continued evaluation of a dietary approach to the treatment of ochronosis; the utilization of the Clinical Research Unit by the Clinical Research Center for Juvenile Rheumatoid Arthritis; and evaluation of surgical procedures, both "prophylactic" and reconstructive, used in the management of arthritis disorders.